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Rollover Contribution Form

Rollover /Recontribution RequestSection C- Investment Election (Participant Completes)Please select either 1 or 2. 1. My Rollover Contribution or return of a previous Coronavirus-Related Distribution or Qualified Birth or Adoption Distribution will be invested in my current investment elections in the plan . If I have not completed an Enrollment form under this plan , my Rollover Contribution will be invested in the plan s default investment option. I understand it is my responsibility to provide investment and/ or exchange instructions through my Employer; by accessing my account online at or by calling Empower retirement s Customer Service Center at My Rollover Contribution or return of a previous Coronavirus-Related Distribution or Qualified Birth or Adoption Distribution will be invested in accordance with my investment elections below.

Rollover Contribution Form. Section C- Investment Election (Participant Completes) Please select either 1 or 2. 1. My rollover contribution will be invested in my . ... or an eligible retirement plan which qualifies this contribution as an eligible rollover; (2) the prior plan or IRA has satisfied such requirements as the Plan may have ...

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